The saying by thespian Glenn Close, “What mental health needs is more sunlight, more candour, and more unashamed conversation”; and by novelist Lemony Snicket, “Just because you don’t understand it, doesn’t mean it isn’t so”; have been coming to my mind in these troubled times of the pandemic.
While all efforts and energies have been focused on the physical healthcare of people, equal attention and focus is needed for ensuring and safeguarding the mental health of all concerned in these trying times. Article 39 of the Constitution of India – part of Directive Principles, interalia requires the State to direct its policy towards securing the health and strength of workers, both men and women; and giving children opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity.
Article 47 casts a duty on the State to regard the raising of level of nutrition and standard of living of its people and improvement of public health as its primary duties. The basic principle underlying mental health legislation is to ensure that persons suffering from mental illness can fully exercise their rights guaranteed under Part–III of the Constitution, including the right against discrimination, right to freedom of speech and expression and the right to life and dignity and its many manifestations as enumerated by the Supreme Court in a catena of judgements.
The legal provisions have to be looked at in terms of how effectively they enable persons with mental illness to exercise these basic rights and to live a full, free and dignified life. The value of living with dignity has been recognised as a core feature of Right to Life guaranteed under Article 21, most recently by a nine-judge bench of the Supreme Court, in KS Puttaswamy Vs. UOI.
The development of Mental Health Legislation in India has been slow yet steady. The Indian Lunatic Asylum Act, 1858, the first codified law on mental health in India, provided only for lunacy proceedings and consequences thereof. The Indian Lunacy Act, 1912, brought the concept of care and treatment of mentally ill persons. The stigma attached with mental illness, however, continued.
The Mental Health Act, 1987(w.e.f. 01.04.1993) reflected that the attitude of society towards persons suffering from mental illness has changed considerably and it is now realised that no stigma should be attached to such illness as it is curable, particularly when diagnosed at an early stage; that mentally ill persons are to be treated like any other sick persons and the environment around them should be made as normal as possible.
The National Human Rights Commission was set up under the Protection of Human Rights Act, 1993 to interalia inquire into violation of human rights-the rights relating to life, liberty, equality and dignity of individuals guaranteed by the Constitution or embodied in the international covenants and enforceable by courts in India. On 01.10.2017, India ratified, the Convention on Rights of People with Disabilities, 2006 (CRPD) which provides greater impetus in promoting rights of Persons with Disabilities (including persons with mental illness) and reaffirms the importance of consent and dignity and obligates the State to ensure such rights and liberties.
This was followed by passing of the Mental Healthcare Act, 2017, a welcome amendment to the 1987 Act. Some significant improvements brought are right to Advance Directives, greater emphasis on consent of patient, codification of rights of persons suffering from mental illness, setting up of Central Mental & State Mental Health Authority, Mental Health Establishments and Mental Health Review Boards for greater institutional accountability.
The word detention has been done away with under the 2017 Act; there is greater emphasis on consent; and concept of Compulsory Admission stands replaced by Supported Admission. These are welcome changes for bringing about change in thinking and perception on mental health. The 2017 Act provides a comprehensive definition of mental illness to mean substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by sub-normality of intelligence.
The pandemic has posed yet newer challenges on mental health of the society. The need therefore exists for not only identifying the new emerging problems and the Mental Health needs of the society, but also providing solutions in a timely manner. With movement restrictions, the tele-mental health counselling and consultation services have been very useful and need to be developed further so as to reach the masses. The physical and mental health practitioners working in close association would lead to better holistic recovery.
Family and friends also play a key role. As per the WHO, health encompasses the composite union of physical, spiritual, mental and social dimension and recognizes that mental health and well-being are fundamental to quality of life, enabling people to experience life as meaningful, become creative and active citizens. WHO on 18.03.2020 has provided a comprehensive Guideline on Mental Health and Psycho Considerations During Covid-19 for the general population, workers, team leaders in health facilities, carers of children and older adults and people in isolation, which is a good reference and a guide. Mental illnesses identified and defined include Depression, Generalized Anxiety Disorder, Bipolar Disorder, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, Schizophrenia and many more.
Addiction to technological and social media has led to newer mental health problems like Internet Gaming Disorder (IGD) and Internet Addiction (IA). While smartphones and social media have their distinct advantages, they have also led to new mental health problems, which we are still in the process of understanding. For instance, looking at other persons on social media and using the content of their social media accounts as a yardstick to judge one’s own life in the real world may lead to emotions such as envy, jealousy or anger.
Similarly, an overdependence on mobile phones/ tablets can also result in deleterious consequences. The fear and anxiety from the pandemic can lead to stress further leading to change in sleeping/eating patterns, worsening of chronic/mental health problems, increased consumption of alcohol, tobacco etc. Concern about availability of medical care and social isolation are some other problems.
Stress, anxiety and depression can result also from loss in business/ professional income, jobs etc. due to the extended lockdown. A well-set routine is a common stratagem used to overcome mental health issues. The pandemic has the effect of breaking such routines, by severely restricting activity beyond one’s house, thereby making it more difficult for mentally ill persons to lead their day-to-day lives. Another issue of concern in the pandemic is the mental health of the homeless and persons with insufficient means.
People with mental health problems if not given appropriate counselling and treatment may become vulnerable to exploitation, abuse, neglect and marginalisation. Therefore, a strong and immediate need exists for addressing such mental health issues.